Background
IBM Watson for Oncology (WFO), which can use natural language processing to evaluate data in structured and unstructured formats, has begun to be used in China. It provides physicians with ...evidence‐based treatment options and ranks them in three categories for treatment decision support. This study was designed to examine the concordance between the treatment recommendation proposed by WFO and actual clinical decisions by oncologists in our cancer center, which would reflect the differences of cancer treatment between China and the U.S.
Patients and Methods
Retrospective data from 362 patients with cancer were ingested into WFO from April 2017 to October 2017. WFO recommendations were provided in three categories: recommended, for consideration, and not recommended. Concordance was analyzed by comparing the treatment decisions proposed by WFO with those of the multidisciplinary tumor board. Concordance was achieved when the oncologists' treatment decisions were in the recommended or for consideration categories in WFO.
Results
Ovarian cancer showed the highest concordance, which was 96%. Lung cancer and breast cancer obtained a concordance of slightly above 80%. The concordance of rectal cancer was 74%, whereas colon cancer and cervical cancer showed the same concordance of 64%. In particular, the concordance of gastric cancer was very low, only 12%, and 88% of cases were under physicians choice.
Conclusion
Different cancer types showed different concordances, and only gastric cancers were significantly less likely to be concordant. Incidence and pharmaceuticals may be the major cause of discordance. To be comprehensively and rapidly applied in China, WFO needs to accelerate localization. ClinicalTrials.gov Identifier: NCT03400514.
Implications for Practice
IBM Watson for Oncology (WFO) has begun to be used in China. In this study, concordance was examined between the treatment recommendation proposed by WFO and clinical decisions for 362 patients in our cancer center, which could reflect the differences of cancer treatment between China and the U.S. Different cancer types showed different concordances, and only gastric cancers were significantly less likely to be concordant. Incidence and pharmaceuticals may be the major causes of discordance. To be comprehensively and rapidly applied in China, WFO needs to accelerate localization. This study may have a significant effect on application of artificial intelligence systems in China.
摘要
背景。IBM 沃森肿瘤 (WFO) 可以使用自然语言处理程序来评估结构化和非结构化格式的数据，我们已在中国开展使用。它可以提供各种基于证据的治疗选择并将它们划分为三个类别，以提供治疗决策支持。本研究旨在检验 WFO 提出的治疗建议与我们癌症中心的肿瘤医生制定的实际临床决策之间的一致性，这可以反映出中美之间的癌症治疗差异。
患者和方法。在 2017 年 4 月至 2017 年 10 月期间，WFO 输入了来自 362 名癌症患者的回顾性数据。按照三种类别提供 WFO 建议:建议、以供考虑和不建议。通过对比 WFO 与多学科肿瘤委员会建议的治疗决策，我们对一致性进行了分析。当肿瘤医生的治疗决策在 WFO 中属于建议或以供考虑的类别时，即表示实现了一致性。
结果。卵巢癌显示出最高的一致性，为 96%。肺癌和乳腺癌取得了略高于 80% 的一致性。直肠癌的一致性为 74%，而结肠癌和宫颈癌显示出相同的一致性，同为 64%。特别值得注意的是，胃癌的一致性非常低，仅为 12%，88% 的病例均由医生选择。
结论。不同的癌症类型显示出不同的一致性，只有胃癌明显不太可能一致。发病率和药物可能是导致不一致的主要原因。为了实现在中国的全面、快速应用，WFO 需要加速本地化。ClinicalTrials.gov 标识符:NCT03400514。
对临床实践的提示:我们现已在中国开始使用 IBM 沃森肿瘤 (WFO)。在本研究中，我们检验了针对我们癌症中心的 362 名患者的 WFO 治疗建议与临床决策之间的一致性，这可以反映出中美之间的癌症治疗差异。不同的癌症类型显示出不同的一致性，只有胃癌明显不太可能一致。发病率和药物可能是导致不一致的主要原因。为了实现在中国的全面、快速应用，WFO 需要加速本地化。本研究可能对人工智能系统在中国的应用产生重大影响。
Using the updated version of IBM Watson for Oncology, this study explored the concordance of the suggested therapeutic regimen between Watson and physicians in China. This article reports results and suggests some similarities and differences between the East and West in the treatment of cancer.
Introduction
Cognitive impairment is a debilitating manifestation in Parkinson’s disease (PD). We sought to investigate predictors of PD-CI (PD with cognitive impairment).
Methods
We systematically ...searched PubMed and Cochrane Library for prospective cohort studies and pooled estimates via random-effects models. Primary analyses for all types of cognitive impairments and subgroup analyses by separate outcomes were conducted.
Results
A total of 28,009 studies were identified, of which 57 studies with 31 factors were included in the meta-analysis. In the primary analysis, 13 factors were associated with PD-CI, comprising advanced age relative risk (RR) = 1.07, 95% confidence interval (CI) = 1.03–1.12, age at onset (RR = 4.43, 95% CI = 1.87–10.54), postural-instability-gait disorder (RR = 3.76, 95% CI = 1.36–10.40), higher Hoehn and Yahr stage (RR = 1.83, 95% CI = 1.35–2.47), higher UPDRS III score (RR = 1.04, 95% CI = 1.01–1.08), rapid eye movement sleep behavior disorder (RR = 3.72, 95% CI = 1.20–11.54), hallucinations (RR = 3.09, 95% CI = 1.61–5.93), orthostatic hypotension (RR = 2.98, 95% CI = 1.41–6.28), anxiety (RR = 2.59, 95% CI = 1.18–5.68),
APOE
ε2 (RR = 6.47, 95% CI = 1.29–32.53),
APOE
ε4 (RR = 3.04, 95% CI = 1.88–4.91), electroencephalogram theta power > median (RR = 2.93, 95% CI = 1.61–5.33), and alpha power < median (RR = 1.77, 95% CI = 1.07–2.92). In the subgroup analysis,
MAPT
H1/H1 genotype increased the risk of dementia in PD. Sixty-four studies were included in the systematic review, of which 12 factors were additionally correlated with PD-CI using single studies.
Conclusions
Advanced age, genetic variation in
APOE
and
MAPT
, gait disturbance, motor assessments, non-motor symptoms, and electroencephalogram may be promising predictors for PD-CI.
Early prevention of Alzheimer's disease (AD) is a feasible way to delay AD onset and progression. Information on AD prediction at the individual patient level will be useful in AD prevention. In this ...study, we aim to develop risk models for predicting AD onset at individual level using optimal set of predictors from multiple features.
A total of 487 cognitively normal (CN) individuals and 796 mild cognitive impairment (MCI) patients were included from Alzheimer's Disease Neuroimaging Initiative. All the participants were assessed for clinical, cognitive, magnetic resonance imaging and cerebrospinal fluid (CSF) markers and followed for mean periods of 5.6 years for CN individuals and 4.6 years for MCI patients to ascertain progression from CN to incident prodromal stage of AD or from MCI to AD dementia. Least Absolute Shrinkage and Selection Operator Cox regression was applied for predictors selection and model construction.
During the follow-up periods, 139 CN participants had progressed to prodromal AD (CDR ≥ 0.5) and 321 MCI patients had progressed to AD dementia. In the prediction of individual risk of incident prodromal stage of AD in CN individuals, the AUC of the final CN model was 0.81 within 5 years. The final MCI model predicted individual risk of AD dementia in MCI patients with an AUC of 0.92 within 5 years. The models were also associated with longitudinal change of Mini-Mental State Examination (p < 0.001 for CN and MCI models). An Alzheimer's continuum model was developed which could predict the Alzheimer's continuum for individuals with normal AD biomarkers within 3 years with high accuracy (AUC = 0.91).
The risk models were able to provide personalized risk for AD onset at each year after evaluation. The models may be useful for better prevention of AD.
This study was performed to describe the clinical features, risk factors, and treatment methods of uterine torsion in pregnancy. The most common symptoms are abdominal pain, fetal heart rate changes, ...and failure of cervical dilatation and are often accompanied by complete or partial placental abruption. Preoperative diagnosis is challenging even with the use of ultrasound. Uterine torsion in the third trimester is correlated with the presence of multiple uterine fibroids. The causes of gravid uterine torsion vary and the clinical manifestations are nonspecific. Early diagnosis and improved detection approaches are the keys to treatment of patients with uterine torsion. However, the preoperative diagnosis remains difficult and the diagnosis is often made during cesarean section.
Background
Estimating the growth of pulmonary sub-solid nodules (SSNs) is crucial to the successful management of them during follow-up periods. The purpose of this study is to (1) investigate the ...measurement sensitivity of diameter, volume, and mass of SSNs for identifying growth and (2) seek to establish a deep learning-based model to predict the growth of SSNs.
Methods
A total of 2,523 patients underwent at least 2-year examination records retrospectively collected with sub-solid nodules. A total of 2,358 patients with 3,120 SSNs from the NLST dataset were randomly divided into training and validation sets. Patients from the Yibicom Health Management Center and Guangdong Provincial People’s Hospital were collected as an external test set (165 patients with 213 SSN). Trained models based on LUNA16 and Lndb19 datasets were employed to automatically obtain the diameter, volume, and mass of SSNs. Then, the increase rate in measurements between cancer and non-cancer groups was studied to evaluate the most appropriate way to identify growth-associated lung cancer. Further, according to the selected measurement, all SSNs were classified into two groups: growth and non-growth. Based on the data, the deep learning-based model (SiamModel) and radiomics model were developed and verified.
Results
The double time of diameter, volume, and mass were 711 vs. 963 days (P = 0.20), 552 vs. 621 days (P = 0.04) and 488 vs. 623 days (P< 0.001) in the cancer and non-cancer groups, respectively. Our proposed SiamModel performed better than the radiomics model in both the NLST validation set and external test set, with an AUC of 0.858 (95% CI 0.786–0.921) and 0.760 (95% CI 0.646–0.857) in the validation set and 0.862 (95% CI 0.789–0.927) and 0.681 (95% CI 0.506–0.841) in the external test set, respectively. Furthermore, our SiamModel could use the data from first-time CT to predict the growth of SSNs, with an AUC of 0.855 (95% CI 0.793–0.908) in the NLST validation set and 0.821 (95% CI 0.725–0.904) in the external test set.
Conclusion
Mass increase rate can reflect more sensitively the growth of SSNs associated with lung cancer than diameter and volume increase rates. A deep learning-based model has a great potential to predict the growth of SSNs.
•Magnetotelluric sounding profile was carried at the Great Xing’an Range.•There are weak crustal zones below the Great Xing’an Range.•The resistivity model supports the delamination of the area.•The ...Songnen Terrane and the Xing’an Terrane sutured in the form of soft collision.
In order to study the lithospheric structure and survey deep resources perspective of the Great Xing’an Range area, a magnetotelluric sounding profile across the central Great Xing’an Range has been completed. The profile starts from the eastern margin of the Hailaer basin, through the Great Xing’an Range to the western margin of the Songliao basin. An electrical structure model of the crust and the upper mantle was finally obtained after data processing, qualitative analysis and 2D inversion of the observed data. The electrical structure can be divided into three tectonic units: the Hailaer basin, the Great Xing’an Range and the Songliao Basin, which is consistent with the regional geology. The research shows that: (1) The high resistivity in the upper crust of the Great Xing’an Range may represent spatially multiple overlapping volcanic rocks, in addition, the low resistivity bodies in the middle-lower crust may reflect hot and weak materials; (2) The lower crust of the Great Xing’an Range may have experienced delamination; (3) There is a lithospheric scale of west-dipping structural transfer zone between the Great Xing’an Range and the Songliao Basin, inferring that the Songnen Terrane firstly subducted to the Xing’an Terrane, then sutured in the form of soft collision, and finally modified by volcanic activities later.
Sex-related difference in Alzheimer's disease (AD) has been proposed, and apolipoprotein E (ApoE) isoforms have been suggested to be involved in the pathogenesis of AD.
We aimed to explore whether ...cerebrospinal fluid (CSF) ApoE is associated with AD biomarkers and whether the associations are different (between sexes).
Data of 309 participants 92 with normal cognition, 148 with mild cognitive impairment (MCI), and 69 with AD dementia from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were cross-sectionally evaluated with the multiple linear regression model and longitudinally with the multivariate linear mixed-effects model for the associations of CSF ApoE with AD biomarkers. Sex-ApoE interaction was used to estimate whether sex moderates the associations of CSF ApoE and AD biomarkers.
Significant interactions between CSF ApoE and sex on AD biomarkers were observed amyloid-β (Aβ):
= 0.0169 and phosphorylated-tau (p-tau):
= 0.0453. In women, baseline CSF ApoE levels were significantly associated with baseline Aβ (
= 0.0135) and total-tau (t-tau) (
< 0.0001) as well as longitudinal changes of the biomarkers (Aβ:
= 0.0104; t-tau:
= 0.0110). In men, baseline CSF ApoE levels were only correlated with baseline p-tau (
< 0.0001) and t-tau (
< 0.0001) and did not aggravate AD biomarkers longitudinally.
The associations between CSF ApoE and AD biomarkers were sex-specific. Elevated CSF ApoE was associated with longitudinal changes of AD biomarkers in women, which indicates that CSF ApoE might be involved in the pathogenesis of AD pathology in a sex-specific way.
Background. The World Health Organization approved the use of Xpert MTB/RIF for the detection of Mycobacterium tuberculosis DNA, which has significantly improved the diagnosis of tuberculosis. In ...this study, our main objective was to evaluate the diagnostic efficacy of Xpert MTB/RIF for lymphoid tuberculosis to determine whether Xpert MTB/RIF could be used as a routine detection method. Materials and Methods. We searched four databases for the relevant literature published from May 2007 to December 2019. The quality of the literature was evaluated with reference to the evaluation criteria. Data that were extracted from the literature on Xpert MTB/RIF diagnosis of lymphatic tuberculosis were used to plot the summary receiver operating characteristic (SROC) curve, after which the software was used to combine and analyze the accuracy of these data. Results. A total of 27 studies were included. The sensitivity of Xpert MTB/RIF for detecting lymphatic tuberculosis was 0.79 (95% CI (0.77, 0.81)), the specificity was 0.88 (95% CI (0.87, 0.90)), and the positive likelihood ratio (PLR) was 7.21 (95% CI (4.93, 10.55)). In addition, the negative likelihood ratio (NLR) was 0.25 (95% CI (0.19, 0.32)) and the diagnostic odds ratio (DOR) was 40.23 (95% CI (24.53, 65.98)). At the same time, we used the extracted data to make the SROC curve, obtaining the following parameters: area under the curve AUC=0.9144, Q=0.8470 (SE=0.0163). Conclusion. Xpert MTB/RIF has high accuracy in detecting lymphatic tuberculosis, and it can be used to quickly and easily diagnose lymphatic tuberculosis at an early stage as a general method.
Cerebral vasospasm is an important cause of poor outcomes in subarachnoid haemorrhage patients. This study was designed to assess the effectiveness and safety of nimodipine in the prevention of ...cerebral vasospasm in aneurysmal subarachnoid haemorrhage patients.
We searched Pubmed, OVID, Embase, the Cochrane library, the stroke clinical trial registry, and the National Science and Technology Library database and collected prospective, randomised, controlled clinical trials of the prophylactic use of nimodipine for aneurismal subarachnoid haemorrhage patients. A meta-analysis was performed on the studies that met the criteria for inclusion.
Eight studies met the inclusion criteria, and 1514 patients finished trial observation for the different indicators. Compared with the placebo group, fully recovered (all cases) patients increased 64% in the nimodipine group (P = 0.0002, OR = 1.64, 95 percent CI 1.26 - 2.13, NNT=-1.048), fully recovered or moderately disabled (all cases) patients increased 79 percent (P = 0.0007, OR = 1.79, 95% CI 1.28 - 2.51, NNT = -5.889), patient death (in cerebral vasospasm cases) decreased 74% (P = 0.008, OR = 0.26, 95% CI 0.09 - 0.71, NNT = 2.298), the incidence of symptomatic cerebral vasospasm decreased 46% (P < 0.00001, OR = 0.54, 95% CI 0.42 - 0.69, NNT = 1.952), the incidence of delayed neurological function deficits (all cases) decreased 38% (P < 0.0001, OR = 0.62, 95% CI 0.50 - 0.78, NNT = 1.078), the occurrence of cerebral infarction (on CT scan) decreased 58% (P = 0.001, OR = 0.58, 95% CI 0.42 - 0.81, NNT = 3.314), the occurrence of cerebral infarction (in cerebral vasospasm cases) decreased 65% (P = 0.003, OR = 0.35, 95% CI 0.17 - 0.69, NNT = 3.688), the occurrence of cerebral infarction (all cases) decreased 48% (P < 0.00001, OR = 0.52, 95% CI 0.41 - 0.66, NNT = 1.196), and the difference in recurrent haemorrhage and adverse reactions between the nimodipine and placebo groups was not statistically significant (nimodipine group versus placebo group, recurrent haemorrhage P = 0.15, OR = 0.75, 95% CI 0.50 - 1.11; adverse reaction P = 0.59, OR = 1.13, 95% CI 0.71 - 1.81).
Compared with placebo, nimodipine can significantly improve clinical outcomes, as assessed by self-formulated standards and Glasgow outcome scores, and it can significantly reduce the occurrence of symptomatic cerebral vasospasm and delayed neurological function deficits (all cases), as well as cerebral infarction, although the incidence rate of recurrent haemorrhage and adverse reactions is not significantly reduced by nimodipine.
The title compound, C18H28O3, was prepared by the reaction of 2,6‐di‐tert‐butylphenol with methyl acrylate under basic conditions using dimethyl sulfoxide as the promoter. The structure of this ...antioxidant indicates significant strain between the ortho tert‐butyl substituents and the phenolic OH group. In spite of the steric crowding of the OH group, it participates in intermolecular hydrogen bonding with the ester carbonyl O atom.
PDF
